IRB on concussion

The IRB takes concussion seriously and has reiterated its concerns about the approach to concussion in the wake of an outcry over the George Smith incident.

The IRB takes concussion seriously and has reiterated its concerns about the approach to concussion in the wake of an outcry over the George Smith incident.

In the third Test between Australia and the B&I Lions, Smith clashed heads with the B&I Lions, hooker, Richard Hibbard, knocked to the ground and, if he was not knocked out, he was seriously dazed. He was led from the filed on wobbly legs for a pitchside concussion assessment.

According to IRB regulations this was to be carried out by a medical officer and was to last five minutes during which time the possibly concussed player would be replaced by another player. If he passed the concussion test and so was declared not concussed, he was allowed to return to the field. Smith returned to the field.

When this was first proposed a year or so ago, an experienced rugby doctor was furious. The doctor was not only an experienced medical practitioner but had played for Ireland and had served on IRB medical committees - Dr Barry O'Driscoll, uncle of Brian who is one of the greatest rugby players of all time. Dr Barry was furious and accused the IRB of trivialising concussion, saying: “There is no test that you can do in five minutes that will show that a player is not concussed...To have this as acceptable in rugby, what kind of message are we sending out?”

The Smith incident seemed to confirm Dr Barry's warning.

The IRB stressed that concussion had to be taken seriously, saying: "The potential for serious and prolonged injury emphasizes the need for comprehensive medical assessment and follow-up until the concussion has fully resolved. Returning to play before complete resolution of the concussion exposes the Player to recurrent concussions that might take place with ever decreasing forces."

4. Cognitive impairment Slowed reaction times, confusion/disorientation, poor attention and concentration, loss of memory for events up to and/or after the concussion

5. Sleep disturbance Drowsiness

Smith had at least three of the physical signs - vacant expression, unsteady legs and slowed reactions. The IRB's regulation says: "If any of the signs or symptoms .... are identified and/or the Player fails to answer correctly the five memory questions... the Player MUST be removed from the field of play for a comprehensive medical evaluation. An assessment of the Player’s balance is likely to form part of this off-field evaluation. The Player MUST NOT resume play once removed from the field for suspected concussion."

The Five Memory Questions

• At what venue are we today?
• Which half is it now?
• Who scored last in this game?
• Which team did you play last week/game?
• Did your team win the last game?

On the memory test, the IRB lays down "Most importantly if a Player ....fails to answer any of the memory questions correctly.. then concussion must be suspected and the Player must be removed from play and referred to a Medical Practitioner or Emergency Department for diagnosis and comprehensive assessment as soon as possible."

The IRB acknowledges that a medical practitioner would not be present at every rugby match. In such a case it says: "If there is no Medical Practitioner or Healthcare Professional present the Player who is injured may be disorientated and unable to make a judgement about his own condition. Fellow Players, coaches, Match Officials, team managers, administrators or parents who observe an injured Player displaying any of the signs ... after an injury event with the potential to cause a head injury or concussion MUST do their best to ensure that the Player is removed from the field of play in a safe manner."

It also says that there is need for aftercare:"The Player must not be left on his or her own and must not be allowed to drive a vehicle. If a medical practitioner is not available on-site the Player must be referred to a medical practitioner for diagnosis and comprehensive assessment as soon as possible."

It also warns: "It should be noted that the symptoms of concussion can first present at any time (but typically in the first 24 – 48 hours) after the incident which caused the suspected concussion."

Then it warns that young players would receive extra care as concussion is often more prevalent in young players. "Whilst the guidelines apply to all age groups particular care needs to be taken with children and adolescents because of the potential dangers associated with concussion in the developing brain. Children under ten years of age may display different concussion symptoms and should be assessed by a Medical Practitioner using diagnostic tools. As for adults, children (under 10 years) and adolescents (10 – 18 years) with suspected concussion MUST be referred to a Medical Practitioner immediately. Additionally, they may need specialist medical assessment. The Medical Practitioner responsible for the child’s or adolescent’s treatment will advise on the return to play process."